China’s HIV epidemic could hinge on doctor training

"Over the last 10 years, HIV started to become transmitted more widely through sexual intercourse, reaching virtually all parts of China. It has now become a priority in China's health system," says Don Operario. (Credit: Safia Osman/Flickr)

Providing training and education to doctors on sexually transmitted infection can significantly reduce infection risk among patients, new research conducted in two Chinese provinces suggests.

The study was a randomized controlled trial of an intensive, customized training program for physicians in sexually transmitted infections.

Patients who saw a doctor who had received the training had a 38 percent lower chance of being infected with gonorrhea or chlamydia within the next nine months than patients of doctors who had not received the training.

“Our trial showed, for the first time, that providing systematic training about HIV and STI prevention, treatment, and behavioral counseling to physicians in China can lead to improved levels of knowledge among those physicians as well as lower levels of new STIs among their patients,” says lead author Don Operario, associate professor of behavioral and social sciences at Brown University.

The researchers organized the trial as China’s epidemic was ramping up in 2007 and 2008. A new national HIV policy announced the year before relied heavily on physicians to stem the tide of new infections, but that corps of medical professionals was not fully prepared to take it on.

“Previously, HIV was considered a small and concentrated epidemic in China and was not a priority for medical education,” Operario says. “Over the last 10 years, HIV started to become transmitted more widely through sexual intercourse, reaching virtually all parts of China. It has now become a priority in China’s health system.”

For the study, published in the Lancet, researchers worked with local experts to prepare and then rigorously test a custom STI training program to see if it would directly benefit patients by reducing their rate of STI infections and risky behaviors.

They recruited 249 doctors who saw STI patients at 51 county hospitals in two Eastern provinces, Anhui and Jiangsu. Doctors at a randomly selected half of the hospitals received the training, while doctors at the other half of the hospitals waited until after the nine-month study period to get the training. The researchers also recruited more than 1,100 patients of the doctors from their waiting rooms.

The training involved a week of on-site education in HIV and STIs including disease biology, epidemiology, treatment, behavioral intervention, and stigma reduction. Doctors would then go back to practice for two months, practicing new knowledge and keeping a journal, and then return for two-day “booster” sessions at the three- and six-month marks.

Doctors and patients were assessed on their knowledge at the beginning and end of the study period. Patients were also asked at the beginning and end about their behaviors such as condom use and were tested for chlamydia and gonorrhea. HIV was the main concern, but it was not common enough to produce significant changes in the study’s sample size. These other more common STIs were.

At the nine-month mark, patients of doctors who received the training were not only significantly less likely to have an STI, but also they were less likely to report engaging in unprotected sex and had higher HIV and STI knowledge. Since the study, Operario has continued to work in China, focusing on subpopulations that have proven to be at greatest risk.

“The epidemic has continued to evolve in China since we started this work, and now disproportionately affects sexual minority men and migrant populations,” he says. “I am currently working with colleagues at Anhui Medical University to develop interventions to reduce HIV and STIs in these high-risk groups.”

Other researchers from Brown and from the University of California–Los Angeles and Anhui Medical University are coauthors of the study. The National Institutes of Health funded the work.